1. Field of the Invention
The present invention is a surgical tool, particularly a drill guide for knee surgery. Exactly locating the exit of a bony tunnel is necessarily a critical part in certain surgical techniques, and particularly the reconstruction of the anterior cruciate ligaments by semitendenosis tenodesis, as previously taught by applicant. See Cho, Kenneth: Reconstruction of the Anterior Cruciate Ligament by Semitendonosis Tenodesis. J. Bone and Joint Surg., 57-A: 608-612, July 1975. As I noted in this paper, there are various surgical techniques for repairing--and even for reconstructing--cruciate ligaments of the knee. The present invention is most helpful with my technique, since it allows quick and accurate location of the exit point of a bony tunnel proximate the former femoral attachment location of a separated anterior cruciate ligament.
For more background upon the anatomy and problems of the anterior cruciate ligament, particular attention is drawn to Girgis, et al., The Cruciate Ligaments of the Knee Joint, Anatomical Funcation and Experimental Analysis, Clinical Orthopedics 106: 216-231, January-February 1975. Another surgical technique which also lends itself to use of the instant surgical tool is that taught by Hay-Groves, The Crucial Ligaments of the Knee Joint: Their Function, Rupture, and Operative Treatment of the Same. British J. Surg. Volume VII, 505-515 (1920). To the applicant's knowledge, the only type of cruciate ligament guide available is the Marcus Stewart cruciate ligament guide, which is primarily for the reattachment of a repairable torn anterior cruciate ligament to its original femoral insertion. See Stewart, M.J.: Campbell's Operative Orthopedics, 5th Edition, page. 929.
2. Description of the Prior Art
Within the general field of orthopedic surgery, there exist a number of drill guides, specifically sized and configured for particular purposes. However, and as previously noted, there is not available a guide which allows particular location of a bony tunnel through the distal end of the femur, as it is particularly necessary for my above-noted technique for reconstructing an anterior cruciate ligament, and particularly by means of using the semitendinosus tenodesis to recreate the function formally performed by the separated anterior cruciate ligament. This technique requires a hole approximately 0.64 cm. in diameter to be exactly located on a surface of the intercondylar notch. Prior to the present invention, this femoral hole was drilled toward the femoral intercondylar notch by rough alignment with a guide wire which was placed at the femoral insertion of the anterior cruciate ligament, to give a measure of orientation.
While drill guides for a specific orthopedic procedure are generally known, particularly for total hip replacements, there is not found in the prior art a device which would accommodate the special needs of an accurately located exit hole in the intercondylar notch of a femur, as required according to both my procedure and other knee reconstructive procedures which were noted above. Prior art patents known to applicant are, as follows:
Great Britain Pat. No. 1,448,111 PA1 Shen Des. No. 245,918 PA1 Schultz U.S. Pat. No. 3,727,611 PA1 Deyerle U.S. Pat. No. 3,814,089 PA1 McGuire U.S. Pat. No. 3,835,489 PA1 Neufeld U.S. Pat No. 3,892,232 PA1 Rambert, et al. U.S. Pat. No. 3,896,500 PA1 Swanson U.S. Pat. No. 3,927,423 PA1 Kronner U.S. Pat. No. 3,945,377 PA1 Cavendish, et al. U.S. Pat. No. 3,949,428 PA1 Treace U.S. Pat. No. 3,953,896 PA1 Charnley U.S. Pat. No. 3,953,899 PA1 Jaquet U.S. Pat. No. 3,961,854 PA1 Hutter, et al. U.S. Pat. No. 3,964,106 PA1 Treace U.S. Pat. No. 3,988,783
These patents illustrate various and sundry drill guides and clamps, for particular applications, such as repairing fractures of the femur or aiding an implantation, such as a total knee prosthesis. Firstly, it is noted that of the above-noted patents, several relate to specific orthopedic modifications of the knee joint.
Cavendish teaches a total knee prosthesis, together with an implantation jig adapted for connection to the femur, in order to locate his prosthetic components with respect to the natural condyles of the femur. As Cavendish shows in FIGS. 3 and 4, and discusses at column 4, lines 50+, his jig includes tubes which act as drill guides for placing certain pins directly into the femur. Cavendish, however, does not address the structurally unrelated problem of reconstructing a cruciate ligament.
Treace U.S. Pat. No. 3,953,896 illustrates one type of prosthetic ligament, and particularly an artificial ligament which has utility for replacing a damaged cruciate ligament. Treace is considered to be merely of interest, since he does not illustrate any device to locate the "natural points" of attachment for his ligament prosthesis. Treace U.S. Pat. No. 3,988,783 illustrates another artificial reconstruction for the knee, with particular focus upon the collateral ligaments.
Rambert, et al. illustrate a ligament reconstruction wherein strands of a polyamide material are encased in a polymer sheath. While Rambert's technique also requires tunnels, 26 and 27, to be bored into the distal end of the femur, there is no particular teaching of a device to ensure the accurate location of such tunnels.
The patents to Swanson, Charnley, and Hutter, et al. simply illustrate further surgical approaches to knee reconstructions, and particularly total knee reconstructions. As such, they are not particularly pertinent to the new device taught herein. For example, Swanson illustrates a patella implant, while Charnley and Hutter illustrate two types of femur and tibia implant approaches in a total knee reconstruction. By contrast, the present invention is concerned with reconstructing a structure to take the place of an anterior cruciate ligament which has been separated from femur, as often happens to athletes. The present invention teaches a device with the particular ability to allow the surgeon to fix the exit point of a bony tunnel inside of the intercondylar notch as a landmark, with relative ease.
Applicant is also aware of certain drill guides which have been specially configured for orthopedic reconstructions of the hip, and particularly drill guides with particular utility for repairing fractures of the femoral neck. For example, the Great Britain patent illustrates one type of clamping device which assists in the repair of an intracapsular fracture of the femoral neck, wherein the drill bit is stopped from proceeding past the bone.
The patent to Schultz illustrates a non-analogous nailing device, wherein the clamp portion is placed around the femur in a manner whereby the lesser trochanter is usable as a reference point for nailing.
The patent to Deyerle teaches another approach to a total hip, wherein he employs a drill jig to assist in the fixation of a prosthesis head member, and also in drilling of the femur.
The patent to Neufeld is enclosed simply to illustrate a tubular drill guide, without any centering ability, and which requires fluoroscopy to locate the pin during a hip implant. The patent to Kronner illustrates a hip pinning tool which clamps directly on the femoral shaft to provide an immobile base, so that his alignment requires only an initial X-ray, and further adjustments being accomplished through calibrations about the axes D, E and along axis C.
The Shen design patent illustrates an ornamental device for an unrelated type of drill guide. The patent to McGuire illustrates a general purpose surgical clamp for holding two bones together, and particularly during a shoulder repair. Finally, the patent to Jaquet illustrates a general purpose device for treating bone fractures, wherein fixation pins can be set and pulled together by moving a screw, 26.
The present invention is particularly configured to allow the surgeon a ready and efficient manner for locating the exit of a bony tunnel within the intercondylar notch, and for this purpose the present invention provides for special relationships for the reconstruction of an anterior cruciate ligament, for example. None of the prior art has approached the special problems inherent in the creation of a bony tunnel in the distal end of the femur for this purpose, as will be more apparent from the following description of the preferred embodiment.